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ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 M16.9

Billable / Specific

Osteoarthritis of hip, unspecified

M16
Block
0
Synonyms
192
LCDs
12
Payer Policies
1
Linked CPTs

About ICD-10-CM M16.9

ICD-10-CM code M16.9 represents Osteoarthritis of hip, unspecified. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M16). The 2026 edition of ICD-10-CM M16.9 became effective on October 1, 2025.

Medicare LCD Coverage for M16.9

Local Coverage Determinations (LCDs) from CMS MACs that list M16.9 as a covered diagnosis.

192 LCDs

Showing top 10 of 192 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27134 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27130 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27487 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27137 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27486 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27138 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27132 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27447 →
CMS LCD: Billing and Coding: Bariatric Surgical Management of Morbid Obesity
Article ID: 56422, Effective: 2026-01-01 00:00:00, 270 covered, 1 non-covered
CPT 43888 →
CMS LCD: Billing and Coding: Bariatric Surgical Management of Morbid Obesity
Article ID: 56422, Effective: 2026-01-01 00:00:00, 270 covered, 1 non-covered
CPT 43846 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing M16.9.

12 policies

2 Cigna

Acupuncture - (CPG024)
Policy ID: CPG024_ACUPUNCTURE
Peripheral Nerve Destruction for Pain Conditions - (0525) ---- future effective policy
Policy ID: MM_0525

5 Medicare

Billing and Coding: Home Health Occupational Therapy
Policy ID: ART-53057
Billing and Coding: Outpatient Occupational Therapy
Policy ID: ART-53064
Billing and Coding: Bariatric Surgical Management of Morbid Obesity
Policy ID: ART-56422
Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Policy ID: ART-56796
Billing and Coding: Surgical Management of Morbid Obesity
Policy ID: ART-57145

3 Aetna

Acupuncture and Dry Needling
Policy ID: CPB-0135
Hip Arthroplasty
Policy ID: CPB-0287
Joint Resurfacing
Policy ID: CPB-0661

CPT Codes Commonly Billed with M16.9

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

1 linkages
  • 27130 Total hip arthroplasty — primary hip OA, bilateral hip OA, osteonecrosis, femoral neck fracture, pathologic fracture Orthopedics

Convert M16.9 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
M16.9 71535 10000
M16.9 71595 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 M16.9, Billing FAQ

Is ICD-10 code M16.9 billable? +

Yes, M16.9 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What CPT codes are commonly billed with M16.9? +

Procedures frequently paired with M16.9 include: 27130.

What ICD-9 codes does M16.9 map to? +

Per CMS GEMs, M16.9 maps to ICD-9 codes: 71535, 71595. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on July 16, 2026.

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